Provider Demographics
NPI:1376819862
Name:JAVOREK, JULIE R (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:R
Last Name:JAVOREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ROSE
Other - Last Name:JAVOREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6201 GENDER RD
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-2007
Mailing Address - Country:US
Mailing Address - Phone:614-834-8042
Mailing Address - Fax:614-837-8035
Practice Address - Street 1:6201 GENDER RD
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-2007
Practice Address - Country:US
Practice Address - Phone:614-834-8042
Practice Address - Fax:614-837-8035
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35123205208000000X, 2080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0123470Medicaid